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Benefit of Longitudinal Pulmonary Artery Pressure Monitoring to Reduce Heart Failure Hospitalization Extends to Obese Patients

2016; Elsevier BV; Volume: 22; Issue: 8 Linguagem: Inglês

10.1016/j.cardfail.2016.06.160

1532-8414

Akshay S. Desai, Muthiah Vaduganathan, Greg Ginn, William T. Abraham, Philip B. Adamson, Maria Rosa Costanzo, J. Thomas Heywood, Lynne W. Stevenson,

Pulmonary Hypertension Research and Treatments

Introduction: Obesity may confound the clinical assessment of volume status in heart failure (HF) patients. Implantable hemodynamic monitoring could aid clinical decision-making in obese patients and reduce the need for hospitalization. Hypothesis: Compared with standard HF care, pulmonary artery pressure (PAP)-guided therapy reduces rates of HF and all-cause hospitalization independent of body mass index (BMI). Methods: The CHAMPION trial randomized 550 subjects with symptomatic HF and previous HF hospitalization to a strategy of HF management with or without wireless PAP monitoring. We analyzed the impact of PAP-guided therapy relative to routine care on rates of HF and all-cause hospitalization during the full duration of randomized access (mean 17.6 months) according to baseline BMI categories defined by the ACC/AHA thresholds for normal (<25 kg/m2), overweight/obese (25–35 kg/m2), and morbidly obese (≥35 kg/m2) using an Andersen-Gill model with an interaction term. Results: Median BMI was 30.0 (IQR 26–35) kg/m2, and baseline PAP did not differ by BMI category. PAP-guided therapy was associated with consistent reductions in HF hospitalization (p[int] = 0.36, Figure) and all-cause hospitalization (pint] = 0.82) across all BMI categories. Conclusions: PAP-guided therapy reduces rates of HF and all-cause hospitalization across a wide range of baseline BMI, suggesting potential for this approach to improve HF outcomes in both obese and non-obese HF populations.